American Psychosis

November 15, 2013

Torrey (executive director, Stanley Medical Research Inst.; psychiatry, Uniformed Services Univ. of the Health Sciences) continues to argue that deinstitutionalization of mental patients has precipitated the deterioration in U.S. psychiatric care, simultaneously flooding communities with untreated and/or homeless populations of the mentally ill. This is not a new argument for Torrey (The Insanity Offense: How America's Failure To Treat the Seriously Mentally Ill Endangers Its Citizens; Out of the Shadows: Confronting America's Mental Illness Crisis), who has spoken out about the issue for years. The book does provide additional historical background on the genesis and collapse of the community mental health movement. The author traces the beginnings of the movement to President John F. Kennedy and his family's guilt about Rosemary Kennedy's lobotomy. Kennedy wrested control of psychiatric institutions from the states, instead creating federal programs that were bound to fail because they were virtually unenforceable and provided no backup support systems for patients who were cast out of hospitals. The leading luminaries at the National Institute of Mental Health successfully lobbied for federalization, thereby leaving the mental health treatment system in shambles. Torrey helpfully offers solutions, maintaining that successful care can come through community mental illness centers, not community mental health centers. In the end, his argument is convincing. VERDICT This powerful polemic presents a compelling case for the reform of the mental illness treatment system.--Lynne Maxwell, West Virginia Univ. Coll. of Law Lib., Morgantown

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Starred review from August 1, 2013
Psychiatrist Torrey (The Insanity Offense: How America's Failure to Treat the Seriously Mentally Ill Endangers Its Citizens, 2008, etc.) returns to the battleground of reform with another book about the inability of government agencies and private institutions to care well for the severely mentally ill. The author names individuals who, in his opinion, are responsible for the disaster of mental health care across the United States. Here, Torrey focuses more on the historical reasons for the sad situation, with special emphasis on the family of President John F. Kennedy. Since Kennedy's sister Rosemary was developmentally disabled and increasingly unstable as she aged, the new president had a high awareness of hidden mental illness problems. But his push for federal mental illness legislation, however well-intended, dismantled the state-based mental hospital system without sensible alternatives in place. As a result, Torrey explains, what became known as "deinstitutionalization" placed tens of thousands of severely mentally ill patients in communities entirely unprepared to care for them. Torrey excoriates the leadership at the National Institute for Mental Health for their inability to anticipate the disaster and subsequent failure to admit their mistakes and take corrective action. After devoting about two-thirds of the text to the historical record, Torrey offers a chapter titled "Dimensions of the Present Disaster, 2000-2013," in which he lucidly explains how community jails and state prisons have become the new centers for warehousing severely mentally ill individuals. The final chapter is filled with sensible recommendations that could be funded by current misguided expenditures that Torrey estimates at about $140 billion annually. The author makes clear that the solutions will require not only vast funding, but also a long-term commitment by trained caregivers, plus family members who insist that their mentally ill relatives be committed to institutions when dangerous to themselves and innocent bystanders. An important book by a refreshingly candid author who shares his vast knowledge in the interests of the needy.

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